From where I stand

Public Trust at Stake in the COVID-19 Crisis

An article in the Washington Post, explains some things about the comparison of COVID-19 to the flu. There’s a more accurate way to compare coronavirus deaths to the flu (by Christopher Ingraham May 2, 2020) explains that flu deaths are estimated based on confirmed reports. The confirmed reports are much, much lower, as a result, than the number of flu deaths the CDC reports.

As an example, he author cites to the 2018-2019 numbers published by the CDC. Confirmed flu deaths were 7,172 , from which the CDC estimated between 26,339 and 52,664 deaths for the year. They do this, apparently, to account for what epidemiologists believe is a sever under-count in the confirmed deaths.

Does anyone see an issue with this in light of what we are learning about the reporting of COVID-19 deaths per the CDC guidelines?

The writer cited to the 63,259 confirmed deaths from COVID-19 (as of May 2, 2020), and speculates that estimating COVID-19 deaths in the same way would result in a number that is “a full order of magnitude” more than the estimated flu deaths. (Today, as of this writing, there are now 87,841 confirmed COVID-19 deaths in the US according to the Johns Hopkins Resource Center.)

The author says the comparison “gets complicated as soon as you realize that flu mortality is not reported as a tally but as an estimated range, which is far different from the individual counts, based on testing and diagnoses, used for COVID-19”. He assumes, as well, that “COVID-19 deaths are probably underestimated”.

But are they? Someone would have to compare the CDC guidelines for reporting flu deaths and compare those guidelines for reporting COVID-19 deaths. I am not an expert in these things, so I will leave it to someone else, but I will address the way COVID deaths are reported below.

The author goes on to highlight how tricky it is to do the comparison. People usually cherry pick the figures that seem right to them: the figures that support what they feel is correct. What else is a non-expert in these things to do?

Thus, the author says, we should trust the experts. When the experts don’t agree, we should trust the consensus. That’s science, right?

More or less, that’s true, but we have a crisis of trust right now that is being exposed by the current epidemic. “Science” or not, people don’t trust the experts. We can speculate all kinds of things about the psychology and sociology of “those people” who don’t trust the experts, but I see some reason to be legitimately concerned, even without giving any credence to crazy conspiracy theories.

I do think we should trust experts, generally. The problem, though, is that even non-experts know that people, including experts, are influenced by biases and personal interests. In that light, the article prompts me to wonder why COVID deaths are so aggressively reported when flu deaths are apparently under counted.

By now people have heard that the reporting of COVID-19 deaths has been aggressive. Dr. Ngozi Ezike, the Director of the Illinois Dept. of Health, explained it this way:

“If you were in hospice and had already been given a few weeks to live, and then you also were found to have COVID, that would be counted as a COVID death. It means technically even if you died of a clear alternate cause, but you had COVID at the same time, it’s still listed as a COVID death. So, everyone who’s listed as a COVID death doesn’t mean that that was the cause of the death, but they had COVID at the time of the death.” Dr. Ezike outlined. (As reported at 25 News on week.com April 20, 2020).

Her explanation to the public didn’t help much, as people now believe the number of confirmed COVID deaths is being inflated (by design or mandate), not under counted. If we consider, now, that flu deaths are intentionally inflated many times over the number of actually confirmed death because of a “belief” that flu deaths are under counted, what is the public to believe?

Even if the aggressive counting of COVID deaths is a reaction to the lax reporting of flu deaths, it doesn’t look good. It doesn’t sit well. People begin to wonder why.

Why would the CDC extrapolate a large number of flu deaths from the small number actually reported? And why mandate aggressive reporting of COVID?

Maybe the belief that flu deaths are under counted is “legitimate”. Maybe the CDC was historically not clear on the importance of reporting flu deaths. Maybe the CDC itself didn’t think reporting flu deaths was important. Maybe the flu has become so commonplace that doctors are not careful in reporting flu deaths.

Maybe the people at the CDC legitimately think the flu vaccines are helpful, even vitally important. Thus, factoring up the number of deaths because of lax reporting is believed to be of vital benefit.

“Fudging” the numbers, however, even for what is believed to be a good thing doesn’t help credibility. Thus, many people may believe the flu numbers may be inflated to motivate people to get vaccinated and to sell more vaccines.

On the other hand, why are COVID-19 deaths being reported so aggressively? If the CDC (apparently) isn’t as aggressive in the guidelines for reporting flu deaths, why have they taken a completely different direction with COVID-19?

I have heard it said that a person who dies in a car accident with a COVID-19 diagnosis is reported as a COVID-19 death. (I don’t know if that is actually true, but it seems to follow from official statements.)

I assume that the CDC has some reason(s) why COVID-19 deaths are being reported so aggressively. The medical profession may also have some motivation to do so because of the insurance reimbursement schedules that increase payouts for COVID-19 treatment. I don’t buy into the conspiracy theories about these things, but, I understand why the seeming inconsistencies leave people wondering what is going on.

It doesn’t help that scientists working with the CDC to develop technology to fight illness, like COVID-19, are aided in the process of patenting those technologies to the benefit of those scientists. The CDC handles the patent application process for them, and the CDC negotiates the licenses for the scientists when the technology is sold on the market. (See the CDC Technology Transfer Process)

Thus, people like Dr. Fauci who are recognized experts, who establish policy and make decisions, like how flu deaths and COVID-19 deaths are to be reported, are also benefiting personally from their involvement. This is a classic conflict of interest.

A conflict of interest occurs when a person in a position of public trust has a personal interest at stake. For instance, if a mayor offered land for sale to the town for in she is mayor, she has a conflict of interest. She is in a position, as mayor, to influence the town to buy the property she owns and maybe even to pay more for it than they should.

Well-established law doesn’t allow those types of conflicts of interest to exist. Who is to say that the town really needed the land or paid the right amount for it with the Mayor on both sides of the transaction?

Even if the town objectively needed the land for a public purpose and paid a fair price for it, allowing Mayor to benefit from her position like that carries the appearance of impropriety. It causes public distrust. For these reasons, the law forbids conflicts of interest to prevent any temptation to public officials to take personal advantage of their position and to preserve public trust in government.

Conflicts of interest at any level erode the public trust. Even if a particular individual is self-aware enough and disciplined enough and altruistic enough not to allow her personal interest to sway her policy decisions, it creates the appearance of impropriety.

As an attorney who represents local government entities, I counsel the elected officials all the time on conflict of interest issues. The courts have been clear that conflicts of interest are not to be tolerated even if a particular individual doesn’t, in fact, take advantage of his or her position to benefit herself because of the temptation that is inherent in a conflict of interest and the public perception of impropriety.

Even well-meaning individuals, though, are influenced by personal interest. It’s human nature. Banding together with other individuals who also have personal interests at stake creates an atmosphere in which confirmation bias is likely to color their thinking. The benefits they receive from the success of their patents, in the case of CDC scientists, are bound to be in background of their minds, if not in the forefront.

Intelligence is not a moral compass. Even very smart people can be morally corrupt, self-serving and worse. Not everyone may be as well-meaning as we suppose.

Smart people tend to be egotistical and arrogant. Add that to the self-interest that goes with a valuable patent, and it’s no wonder public distrust is high. Even a well-meaning person with a large ego is going to go to some length to defend and promote his or her particular patent and the need to use it.

As an attorney, I am shocked to find conflict of interest built (intentionally it seems) into the model of how medicines are developed. I understand the need to motivate smart people to go into the field, but there is no need to open the doors to conflicts of interest to accomplish that goal.

Allowing conflicts of interest, erodes the integrity of the system at its core.

If our experience with the current virus threat has exposing anything, it is that public distrust is very high. In that light, the way the CDC and the National Institute of Health does things needs to be reexamined. Conflicts of interest should be taken seriously, and measures should be taken to eliminate them just as aggressively as COVID-19 cases are reported.

Conflicts of interest have no place in these matters that involve life and death any more than they have in local governance (where they are effectively prohibited). People are people. All people are susceptible to flaws and biases and the undo influence of personal interest. The public good and the public trust demand that we do better. If we don’t, the public trust will continue to erode, and greater civil crisis will follow.

Postscript and Disclaimer:

I have not verified that the guidelines for reporting flu deaths is different from the guidelines for reporting COVID-19 deaths. My understanding of the way scientists at the CDC are able to patent their inventions to their own benefit may be inaccurate. The influence those same scientists have on the policies of the CDC and NIH may not be as direct as I suppose (though any influence in my mind is problematic). Dr. Fauci may not, in fact, have benefited from his own patents or had the kind of influence I suppose he has had on the policies in place.

Maybe what we have is a crisis of lack of information or misinformation. Either way, “just trust the experts” isn’t a satisfactory answer to the public distrust. We need transparency in government, and we need good communication.